What is a Medical Billing Specialist?

Key Insights:

• Medical billing specialists help healthcare providers collect and track reimbursements for goods and services provided. They do this by submitting claims to insurance companies and then billing patients for their portion of the expenses.
• While medical billing is different from medical coding, it’s important that medical billing specialists understand coding. This knowledge is needed to verify patient health information accuracy, as well as to fix rejected insurance claims due to coding issues.
• Medical billing specialists must know medical terminology and benefit from skills related to communication, computers, and the usage of basic office equipment. A medical billing program can prepare you to work in this healthcare role.

Since clinical healthcare workers are focused on patient care, it often falls to trained specialists to manage the important administrative work of medical billing. This helps healthcare providers get reimbursed for their services.

Does the idea of working as a medical billing specialist sound appealing to you? Let's take a look at what this position does, as well as how medical billing training can help prepare you for this role.

What Is a Medical Billing Specialist?

A medical billing specialist helps healthcare facilities manage insurance claims, invoices, and payments. They do this by submitting claims to insurance companies for reimbursement, then billing patients for their portion of the remaining expenses.

In 2023, Americans spent $4.9 trillion on health-related expenditures, such as hospital care, doctor bills, and prescription drug expenses.¹ Medical billing specialists help healthcare providers collect monies owed to their organizations and practices for these products and services.

Medical billing vs. medical coding

Medical billing and medical coding are often combined in a single position, with a job title of medical billing and coding specialist — commonly referred to as a medical biller and coder. However, these are technically two different job functions.

Understanding the differences can help you decide the right career path for you. Here's a breakdown of each healthcare role:

• Medical coding is the act of taking a provider's diagnostic and procedural notes and converting them into universally accepted alphanumeric codes for record-tracking and billing purposes. This requires knowledge of the different code sets, as well as knowing how to select the correct ones based on a patient's diagnosis, treatment, and services.
• Medical billing involves the use of medical codes to send claims to the patient's insurance provider (or other payers), billing the patient for their portion of the expenses. Based on the codes selected, insurance companies will approve or deny the request for payment. This underscores the importance of medical code accuracy.

Smaller medical offices may hire one person to do both medical billing and coding, while larger healthcare facilities may divide the work into two separate positions, hiring both a medical billing specialist and a medical coding specialist.

Understanding the medical billing process

The medical billing process often begins when patients make an appointment, as codes may be entered and submitted to insurers for pre-approval. This helps determine what the patients' out-of-pocket expenses will be, so the office knows what amount to charge them at the time of the visit.

After the visit, medical billing specialists submit claims to the patient's insurance company for reimbursement, invoicing the patient for the rest. Medical billers also determine co-pay requirements, track payments, and follow up on outstanding monies owed from insurance companies and patients.

If a bill goes unpaid, the medical billing specialist contacts the insurance companies to make sure all the paperwork is in order. If a patient does not remit payment for an outstanding bill within a specified timeframe and fails to respond to further requests, the debt may be turned over to a collection agency.

Medical Billing Specialist Duties and Responsibilities

Day-to-day responsibilities of a medical billing specialist can include:

• Preparing and sending invoices or claims for payment
• Correcting and resubmitting rejected claims
• Tracking insurance company, patient, and third-party payments
• Following up with patients and insurance companies for outstanding bills

The medical billing specialist role is primarily an office job as opposed to patient-facing clinical work. These professionals spend a large amount of time at the computer, where they review, enter, and update information.

What Do You Need to Know to Work as a Medical Billing Specialist?

A medical billing specialist needs certain knowledge and skills to perform their job duties efficiently and effectively. Familiarity with medical codes is an important requirement, but there are other knowledge areas that you should know as well.

• Medical terminology. Understanding commonly used terms in the medical profession is necessary for managing the billing process. This includes anatomy and physiology terms, diagnosis and procedural terminology, etc. A knowledge of medical billing and coding terminology, specifically, is important, too.
• Basic math skills. A fundamental understanding of basic arithmetic is needed to determine proper billing amounts. While electronic billing systems may automatically populate forms with the proper amounts for insurance claims based on the codes entered, medical billing specialists may need to calculate the remaining amount due from patients or set up payment plans where applicable.
• Communication skills. Billing specialists may have to contact patients for payment. An ability to communicate effectively and professionally can make these conversations easier, especially when dealing with patients who may be stressed, upset, or angry when faced with medical problems and a large or unexpected bill.
• Computer skills. The medical billing process requires a working knowledge of computer systems and relevant medical software. The ability to learn new programs is also a plus, both as a new medical billing specialist and when working for an employer that switches software or to learn software that is updated with the latest technology.
• Use of basic office equipment. In addition to having a level of computer proficiency, a medical billing specialist needs to be able to use other basic equipment. This can include knowing how to operate a 10-key calculator, printer, copier, scanner, phone system, and the like.

Medical billing specialist job descriptions can provide more information about the skills requirements for specific employers. They can help determine whether you qualify for that opening, or if additional skills, training, or experience are needed.

Who May Be a Good Fit for a Medical Billing Specialist Role?

If you have good organizational skills, are detail-oriented, able to manage time well, and adept at handling multiple projects, this role might be a good fit for you. Medical billing specialists should also be comfortable in an office setting, as the job requires a lot of time in front of a computer screen and working with patients' files.

It's important to have a good grasp of medical terminology as a medical billing specialist, or at least be willing to learn it. Workers in this field must also stay up to date on changes in procedures and medical coding guidelines, so an interest in continued learning is another good quality for this role.

If this description sounds like you, you might be interested in a medical billing specialist career path.

Get Started as a Medical Billing Specialist

Ultimate Medical Academy (UMA) offers two programs that can help prepare you for the medical billing specialist role:

• A Medical Billing and Coding Diploma program, which can be completed in 11 months or more²
• A Medical Billing and Coding Associate of Science / Associate of Applied Science Degree program, which can be completed in 18 months or more²

Both programs provide the field-specific skills needed to pursue entry-level medical billing roles. The associate program also includes soft skills that potential employers may look for.

Contact us today for more information, or to learn how we can help you pursue your healthcare career goals.

FAQs

• What does a medical billing specialist do? A medical billing specialist submits claims to insurance companies for reimbursement of medical expenses. They also submit bills to patients for their portion of the services rendered, recording payments once they are received.
• How long does it take to become a medical billing specialist? The amount of time it takes to become a medical billing specialist can differ based on the training program length and on whether you earn a diploma or degree. Ultimate Medical Academy's diploma program takes 11 months, or more, to complete, and the associate degree program takes approximately 18 months, or more, to finish.²
• How much does a medical billing specialist make? Medical billing specialist pay can vary based on your level of education, experience, geographical location, and more. Check local job posts to learn more about pay in your area. Online resources can also provide information, such as data provided by the Bureau of Labor Statistics (BLS). The BLS doesn't provide pay data for medical billers specifically, but this information is included under the umbrella of wages for medical secretaries and administrative assistants.
• How do you become a medical billing specialist? While some healthcare agencies may hire medical billing specialists with a high school diploma and previous experience, the Bureau of Labor Statistics reports that additional training to learn industry-specific technology may be required.³ A medical billing and coding program, such as the ones offered by UMA, can help prepare you for this role.